Margin Quality Analysis and Risk Factors Associated With Insufficient Margins Following Segmentectomy for Small-Sized Non-Small Cell Lung Cancer.

BACKGROUND

Segmentectomy has been recognized as non-inferior to lobectomy for the treatment of small-sized non-small cell lung cancer (NSCLC). This study aimed to identify factors associated with the margin quality of segmentectomy.

METHODS

Patients with small-sized NSCLC (≤ 2 cm) who underwent segmentectomy between January 2019 and December 2023 were screened. A sufficient surgical margin was defined as ≥ the maximum tumor diameter. Logistic regression analyses were performed to identify factors associated with insufficient margins following segmentectomy.

RESULTS

A total of 667 patients were included. Of them, sufficient surgical margins were achieved in 577 patients (86.5%). Compared to patients with sufficient margins, those with insufficient margins had larger tumor sizes, longer tumor-to-pleura distances, shorter tumor-to-segmental bronchus distances, and higher percentages of central tumors and intersegmental tumors. Multivariate logistic regression analysis revealed that tumor size (OR = 2.97, p = 0.002), tumor-to-pleura distance (OR = 1.26, p = 0.045), tumor-to-segmental bronchus distance (OR = 0.76, p = 0.011), and tumor subsegmental attribution (intersegmental vs. intrasegmental tumors, OR = 2.13, p = 0.003) were significantly associated with the margin quality of segmentectomy. The optimal cutoff values to stratify the risk of insufficient margins were 1.1 cm for tumor size, 3.0 cm for tumor-to-pleura distance, and 5.2 cm for tumor-to-segmental bronchus distance, respectively. Notably, 98.9% (89/90) of patients with insufficient margins exhibited at least one of these identified risk factors.

CONCLUSIONS

Tumor size, tumor-to-pleura distance, tumor-to-segmental bronchus distance, and nodule subsegmental attribution might be correlated with insufficient margins during segmentectomy. Surgeons should exercise extra caution when performing segmentectomy for patients with tumors harboring multiple such high-risk features.